Aseptic Meningitis From Lamotrigine -- A New Headache for People With Epilepsy?
Aseptic Meningitis From Lamotrigine -- A New Headache for People With Epilepsy?
On August 12, 2010, the US Food and Drug Administration (FDA) warned that Lamictal® (lamotrigine) may cause aseptic meningitis. More details are available in this Medscape News Article. Updated prescribing information and patient medication guides from the manufacturer, GlaxoSmithKline, will soon be available.
According to Yolanda Fultz-Morris, from the FDA's Center for Drug Evaluation and Research, "Aseptic meningitis is a rare but serious side effect of Lamictal®."
Aseptic meningitis typically presents with symptoms of meningeal infection (eg, fever, headache, stiff neck, lethargy, confusion, photophobia) resembling bacterial meningitis but with negative spinal fluid bacterial cultures. The cause is usually a virus, most commonly enterovirus. Other etiologies include mycobacteria, fungi, spirochetes, autoimmune disease, parameningeal infections, malignancies, and medications.
Medications are usually last on the list when considering possible etiologies for aseptic meningitis and remain a diagnosis of exclusion. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are the most common medication causes. Other offenders include antimicrobials such as trimethoprim-sulfamethoxazole, intravenous immunoglobulins, monoclonal antibodies, and vaccines. Among antiepileptic drugs, carbamazepine has also been associated with aseptic meningitis.
There is no confirmatory test for lamotrigine-induced aseptic meningitis. A lamotrigine rechallenge is probably ill advised, as symptoms may be more severe after re-exposure. Possible risk factors include systemic lupus erythematosis or other autoimmune diseases. The pathophysiology of lamotrigine-induced or other drug-induced aseptic meningitis is presumed to be an allergic or nonallergic hypersensitivity mechanism.
FDA Warning
On August 12, 2010, the US Food and Drug Administration (FDA) warned that Lamictal® (lamotrigine) may cause aseptic meningitis. More details are available in this Medscape News Article. Updated prescribing information and patient medication guides from the manufacturer, GlaxoSmithKline, will soon be available.
According to Yolanda Fultz-Morris, from the FDA's Center for Drug Evaluation and Research, "Aseptic meningitis is a rare but serious side effect of Lamictal®."
Clinical Presentation
Aseptic meningitis typically presents with symptoms of meningeal infection (eg, fever, headache, stiff neck, lethargy, confusion, photophobia) resembling bacterial meningitis but with negative spinal fluid bacterial cultures. The cause is usually a virus, most commonly enterovirus. Other etiologies include mycobacteria, fungi, spirochetes, autoimmune disease, parameningeal infections, malignancies, and medications.
Medications are usually last on the list when considering possible etiologies for aseptic meningitis and remain a diagnosis of exclusion. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are the most common medication causes. Other offenders include antimicrobials such as trimethoprim-sulfamethoxazole, intravenous immunoglobulins, monoclonal antibodies, and vaccines. Among antiepileptic drugs, carbamazepine has also been associated with aseptic meningitis.
There is no confirmatory test for lamotrigine-induced aseptic meningitis. A lamotrigine rechallenge is probably ill advised, as symptoms may be more severe after re-exposure. Possible risk factors include systemic lupus erythematosis or other autoimmune diseases. The pathophysiology of lamotrigine-induced or other drug-induced aseptic meningitis is presumed to be an allergic or nonallergic hypersensitivity mechanism.
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